Provider Demographics
NPI:1508097155
Name:PRIBBLE, JAY (PA)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:PRIBBLE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:3051 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2023
Mailing Address - Country:US
Mailing Address - Phone:817-468-1818
Mailing Address - Fax:817-468-4775
Practice Address - Street 1:3501 S CENTER STREET
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014
Practice Address - Country:US
Practice Address - Phone:817-468-1818
Practice Address - Fax:817-468-1818
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06256363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical